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Customer Application
File Size:
54 kb
File Type:
pdf
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ECD Properties Customer Application
How can we help you?
*
Rental
Home Ownership
Emergency Housing
Applicant
*
First
Last
Current Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
-
-
Email
*
Household Size
*
Enter number of individuals who will be living in the household; be sure to provide their names, dates of birth, and relationship to applicant in fields at the bottom of this form.
I Currently:
*
Rent
Own
Other
Do you have Section 8, TRA, or another form of rental assistance?
*
Yes
No
When do you hope to move?
*
Does anyone in your household currently earn wages through employment?
*
Yes
No
Do you, or anyone who will be living in your home, bring home a paycheck from a job or earn money through self-employment?
If so, how much monthly? (total before taxes)
*
Enter the total pre-tax employment earnings from all members in your household. You will need to submit one month of paystubs for all jobs held by household members to complete this application.
Does anyone in your household currently receive payments through social assistance programs such as Welfare or Social Security?
*
Yes
No
If so, how much monthly?
*
Enter the total payments to all members in your household. You will need to submit proof of support for any household members receiving assistance to complete this application.
Does anyone in your household have any income other than employment income or social assistance. This includes pension, alimony, and child support.
*
Yes
No
If so, how much monthly?
*
Enter any monthly income received by any household members. You must provide proof of this income to complete this application.
How did you find out about our organization?
*
Household Member #2
*
First
Last
Household Member #2 - Date of Birth
*
Household Member #2 - Relationship to Applicant
*
Household Member #3
*
First
Last
Household Member #3 - Date of Birth
*
Household Member #3 - Relationship to Applicant
*
Household Member #4
*
First
Last
Household Member #4 - Date of Birth
*
Household Member #4 - Relationship to Applicant
*
Household Member #5
*
First
Last
Household Member #5 - Date of Birth
*
Household Member #5 - Relationship to Applicant
*
Household Member #6
*
First
Last
Household Member #6 - Date of Birth
*
Household Member #6 - Relationship to Applicant
*
Comments
*
Provide any other information that you think may be helpful to us in evaluating your application. Also, please submit the names, dates of birth, and relationship to applicant for any household members for whom there was insufficient space on this form.
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